Healthcare Provider Details

I. General information

NPI: 1831787050
Provider Name (Legal Business Name): STEPHANI OLDENBURG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 12/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLLEGE AVE FL 2
APPLETON WI
54911-5826
US

IV. Provider business mailing address

URB DORADO DEL MAR 61 VILLA ESTE
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 866-288-8001
  • Fax:
Mailing address:
  • Phone: 715-889-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242748
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: